Permit CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
° COMMUNITY DEVELOPMENT Permit #: FPS2009 -00006
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/19/2009
Parcel: 2S102CB02300
Jurisdiction: Tigard
Site address: X3240 SW PACIFIC HWY
Subdivision: ~ Lot: 0
Project: Westside Surgery
Project Description: Add (1) fire sprinkler head to provide proper coverage for shelving.
Owner: FEES
PACIFIC PROPERTIES Description Date Amount
BY MARTIN JOHNSON, 13200 SW PACIFIC HWY Permit Fee - COM 03/19/2009 $62.50
TIGARD, OR 97223 Tax - 12% State Surcharge 03/19/2009 $7.50
PHONE:
Contractor:
VIKING AUTOMATIC SPRINKLER CO
3245 NW FRONT AVE
PORTLAND, OR 97210
PHONE: 503 - 227 -1171
FAX: 503 - 227 -1552
Type of Use: COM
Class of Work: FPS Type of Const:
Occupancy Grp: Height: ft
Stories:
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type:
Standpipe Required: Hazard:
Density: 0 Design Area: 0
K Factor: 0
Commercial Fire Alarm System:
Fire Alarm Required: Alarm Type:
Pull Station Required: Smoke Detectors Req:
Battery Calcs Provided: Cut Sheets Required:
Total $70.00
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 550.00
Residential Square Footage: 0
Fire Alarm Valuation: 0
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility : • ca ion - • -r. Those s are set forth in OAR 952 - 001 - 0010 through OAR 952 - 001 - 0100. You may obtain a copy of the rules
Iss ed By: / 4 //I Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept In a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Fire Protection System
Buildin Permit A lication . FoR oFncE ush: °NIA.
City of Tigard Received i Perm • No.
g DateB ,� /04 .Ap!r /
IN 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review'
m . Phone: 503.639.4171 Fax: 503.5.S1t3p1R6t)1 9 2009 Date/B Other Permit:
l I G n I: D Inspection Line: 503.639.4175 ill Date Ready /By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov OF Notified/Method: Notified/Method: Supplemental Information
TY Ciw u.TlJ NF CIR(�K NISION
REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
p Addition/alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ I- and 2- family dwelling • JCommercial/industrial
Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: (324 S �/ p I p.i r ik w q New dwelling area: square feet
City/ State/ZIP: --r D hCZ Q /7.Z3 Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: we,sT,St1Ue. Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
-
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: - Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.:
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $ S T O °®
APO ,tzt el KLE2 iteig) Td j7iPo t of
/1 Existing building area: square feet
eavAle r AaE lc 1ftElv
• New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: v,i t . t /NF . 5 ° L) 17 - ell &O" Type of construction:
Address: icy (7 .5.,� l.( l tc 4,,, H Occupancy groups:
City/State/ZIP: -- I - t a W a by 17723 Existing:
Phone: ( 4,31 - 4,5-7( Fax: ( ) New: , •
53 APPLICANT ❑ CONTACT PERSON NOTICE
Business name: v1 v 1 N ktztv 01,1/4 y lC 151' z. I Q K (EfZ All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
�i AJF. � M+l Ai.... under ORS 701 and may be required to be licensed in the
Address: 3Z4.1- N41/4) Teo' -s i A vE jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City/State/ZIP: a 97z to . apply:
Phone: (s3)ZZ7 - ll ?I Fax: :(2 ZZ7 /S - L
E -mail:
CONTRACTOR • BUILDING PERMIT FEES''
Business name: (Please refer to fee schedule) .
1/IKIP tISTot1.At471c Sp1zt►Jkwiz 6/.2.
_ 0 � / Permit fee: �
Address: 3Zz{ S 14,...) - f - tlz� bkUE ���
Cit / State/ZIP: State surcharge ° of permit fee): ? . 5a
y �otaC"I 4 ,,,-,, oa 0172 -1
FLS plan review (40% of permit fee):
Phone: (So3) zZ7 - I t Fax: ( ) (Due upon application.)
CCB lic.: %ozi S 37 Total permit fees: 7D .o0
Authorized si ia Amount received: 70 .6C-) .6C-) c
This permit application expires if a permit is not obtained
Print name: Date: C, within 180 days after it has been accepted as complete.
��vE���� `�_ l� _ l • Fee methodology set by Tri -County Building Industry
Service Board.
I: \Building\Permits\ FPS-Permit App.doc 03/23/06 4404613T(11/02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist •
Page 2 - Supplemental Information
Describe work to be done: •
1.) ❑ New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan review required.
[Z Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads:
Additional description of work: igo• akEylv, — 25 t p€ LovEctiAc
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor S. (o
Sprinkler Project Valuation: $ 5
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component ❑ Yes
Cut Sheets
Fire Alarm Project Valuation: $
•
D.) Residential Sprinkler (Stand Alone System)
Square Footage: Permit Fee:
0 to 2,000 $187.50
2,001 to 3,600 $232.50
3,601 to 7,200 • $292.50
7,201 and greater $381.50
Sprinkler Project Square Footage: sq. ft.
Fire Protection Permit Fees
Project valuation subtotal (see A, B & C above): $
Permit fee based on project valuation (see fee schedule): $
Permit fee based on square footage (see D above): $
State Surcharge (8% of permit fee): $
FLS Plan Review (40% of permit fee): $
TOTAL: $
. Plan review requires a completed application and 2 sets of plans at submittal. Plan review fees are required at submittal.
"New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression
engineer, or NICET level "3" technicians.
P: \OREGON JOBS \Permit Applications \City of Tigard Permit App.doc 2
•
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STATE OF OREGON
GENERAL NOTES _ _ LICENSE SPRINKLER SYMBOL DESCRIPTION I�EAO 14�Et Tc 4�vbvtoF �� -,PFV7 NO.64837 SYMBOL STYLE I MAKE MODEL 1 SIZE K- Factor TEMP SIN # , FINISH CANOPY TOTAL N
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_1. .'' — — LONGVIEW _. _ ... _ PORTLAND, OREGON - — • MEDFORD
3246 N.W. FRONT AVE. 97210: • (609) 227 -1171
. WESTSIDE SURGERY
- 13240 SW PACIFIC HvWY
TOTAL SPRINKLERS SHOWN ON THIS SHEET T I G A R D A R 97223
JOB N0. DRAWN BY: DATE SCALE: DRAWING NO.
- TOTAL SPRINKLERS REQUIRED ON THIS CONTRACT t °PT 91L,7_ 'D. Bw , . 3 ■ :. O°I 3 I , _ ' I of 1